TCAR ACTUAL EXAM QUESTIONS AND ANSWERS
SET A+
✔✔what is a simple pneumothorax - ✔✔any air that enters the pleural cavity can also
leave at the same rate. lungs deflated but no increase in intrathroacic pressure. air
in/out exits at the same rate. pt might be able to tolerate a simple pneumothraox
causes a problem at the ventilation point at the tissue oxygen cascade
✔✔intrathroacic pressure in simple pneumothorax - ✔✔air that enters the pleural cavity
leaves at the same rate
lungs are deflated but no increase in pressure
air in/out at the same rate
✔✔where is the problem in the tissue oxygenation cascade in simple pneumothroax -
✔✔ventilation
✔✔what happens in penumothorax - ✔✔lungs are collapsed/deflated
aire enters space between the visceral & parietal
✔✔two layers of the lungs - ✔✔visceral & parietal
✔✔Q - in a pneumothorax, no ligaments attach the lung to the wall. so what holds it up?
- ✔✔A - a thin layer of pleural fluid & negative pressure. the liquid helps it stick like how
a spilled liquid forms a seal between a glass and a smooth table top
✔✔difference between a simple and tension pneumo - ✔✔
✔✔aka chest tube - ✔✔chest thoacotomy
✔✔purpose of using a chest tube in simple pneumothorax - ✔✔to allow for negative
pressure to reestablish .
,✔✔tension pnumothorax - ✔✔air enters under pressure but doesn't exit at the same
rate. = accumulation of air under pressure
✔✔example of tension pneumothorax - ✔✔like using a bicycle pump to put more and
more air into the lungs over time. no escape
*pressure means no lung function on the side of the injury and compromises function on
the un injured heart and great vessel compression
(decreases preload/CO
increases afterload
✔✔effect of tension pneumothorax on heart function - ✔✔increases intrathoracic
pressure
decreases preload/CO
increases afterload
✔✔normal pressure in the vena cavas - ✔✔normally is low
similar to the central venous pressure which is similar to right atrial pressure (2-8mm
hg) so very little increase in pressure to impede venous return to the heart
✔✔what part on the tissue oxygenation cascade is affected by tension pneumothorax -
✔✔ventilation r/t collapsed lung
CO b/c pressure
✔✔why is tension pneumothorax more life threatening than simple pneumothorax -
✔✔tension pneuma is more life threatening than simple b/c of the pressure it puts on
the great vessels so decreased CO
✔✔considerations of chest trauma - ✔✔pneumonia, great vessel trauma, pressure so
low CO
✔✔when is a hospitalized chest patient the most likely to develop tension pneumothrax
- ✔✔when we initiate positive pressure ventilation
✔✔what can rapidly convert a simple pneumothorax to a tension pneumothraox -
✔✔positive pressure can rapidly convert a simple pneumothorax to a tension
pneumothorax (BVM or m. ventilation) or if a chest tube is kinked/clamped/occluded
✔✔chest pain w/breathign - ✔✔pleuritic
✔✔pleuritic chest pain - ✔✔pain with breathing
✔✔assessment of t. pneumothraox - ✔✔pleuritic chest pain (hurts to breathe)
respiratory distress
increased HR
,hyppoxemia
agitation
decreased LS
chest dyspmetry
hyperresonance
✔✔late s/s of tension pneumothrax - ✔✔low bp
JVD
tracheal deviation
✔✔when do you get tracheal deviation - ✔✔late sign of tension pneumothrax
✔✔when isn't JVD & tracheal deviation obvious in tension pneumothroax - ✔✔not
obvious if obese, low bp, cervical collar
also - it is a super late s/s
✔✔intervention if you suspect tension pneumothrax - ✔✔needs FAST
do immediate needle D w/o imaging
✔✔mortality rate off tension pneumothorax - ✔✔100% of patients will die w/o
intervention
✔✔too much black on CXR - ✔✔hyperlucency
✔✔needle "d" for tension pneumo - ✔✔"pop the bubble" with needle/finger.
to restore CO. life saving
✔✔finger thoracotomy - ✔✔
✔✔purpose of "needle d" - ✔✔convert tension pneumo to a simple pneumo.
then put in chest tube
✔✔how to convert a tension pneumothorax to a simple pneumo - ✔✔"needle D"
✔✔open pneumothorax - ✔✔object penetrates or a rib pokes out
✔✔intervention for an ope. pneumothroax - ✔✔xeroform, gasoline bandage, chest seal.
✔✔assessment of the site of a chest tube site - ✔✔consider how it might be a potential
site of an open pneumo
✔✔hemothorax causes problems at what point of the tissue oxygen cascade - ✔✔hgb
availability
ventilation issue b/c lung collapses
, CO problem if enough blood is lost
small venin/arteries below each fib so a broken rib could cause hemothraox
bleeding from intercostal vessels should not be extensive and taper off quickly so
continuous bleeding is likely a different vessel
✔✔considered too much chest tube drainage - ✔✔1-1.5L at initial palcement
50-200ml over 2-4hrs
✔✔how much blood can be in one hemothroax - ✔✔500 - 3L
✔✔% blood loss that is tolerable versus not tolerable - ✔✔most people can tolerate a
10% blood volume loss but most can't tolerate 40%
✔✔how to tell if something is blood or air on a CXR - ✔✔blood = white
black = air
✔✔intervention if hemothorax - ✔✔needs CT
later will need intrapleura tPA or VATS
✔✔VATS - ✔✔video-assisted thoracic surgery
✔✔empyema - ✔✔
✔✔added to blood products that may cause low Ca - ✔✔citrate.
✔✔purpose of citrate in blood products - ✔✔w/o citrate, blood will clot
✔✔keeps blood in blood products from clotting - ✔✔citrate
✔✔priority in bleeding episodes - ✔✔stop bleeding
CABC
✔✔leading cause of early mortality in trauma - ✔✔hemorrhage
✔✔cause of 30 - 40% of all patients who die of trauma - ✔✔hemorrhage
✔✔why is it important to keep a hemorrhage pt warm - ✔✔keep a trauma pt warm helps
stop bleeding b/c you can't clot well if cold
✔✔coagulopathy control in hemorrhage - ✔✔can't clot if we only give RBC/crystallids
needs plasma, cry, plt
✔✔definitive bleeding management - ✔✔OR
SET A+
✔✔what is a simple pneumothorax - ✔✔any air that enters the pleural cavity can also
leave at the same rate. lungs deflated but no increase in intrathroacic pressure. air
in/out exits at the same rate. pt might be able to tolerate a simple pneumothraox
causes a problem at the ventilation point at the tissue oxygen cascade
✔✔intrathroacic pressure in simple pneumothorax - ✔✔air that enters the pleural cavity
leaves at the same rate
lungs are deflated but no increase in pressure
air in/out at the same rate
✔✔where is the problem in the tissue oxygenation cascade in simple pneumothroax -
✔✔ventilation
✔✔what happens in penumothorax - ✔✔lungs are collapsed/deflated
aire enters space between the visceral & parietal
✔✔two layers of the lungs - ✔✔visceral & parietal
✔✔Q - in a pneumothorax, no ligaments attach the lung to the wall. so what holds it up?
- ✔✔A - a thin layer of pleural fluid & negative pressure. the liquid helps it stick like how
a spilled liquid forms a seal between a glass and a smooth table top
✔✔difference between a simple and tension pneumo - ✔✔
✔✔aka chest tube - ✔✔chest thoacotomy
✔✔purpose of using a chest tube in simple pneumothorax - ✔✔to allow for negative
pressure to reestablish .
,✔✔tension pnumothorax - ✔✔air enters under pressure but doesn't exit at the same
rate. = accumulation of air under pressure
✔✔example of tension pneumothorax - ✔✔like using a bicycle pump to put more and
more air into the lungs over time. no escape
*pressure means no lung function on the side of the injury and compromises function on
the un injured heart and great vessel compression
(decreases preload/CO
increases afterload
✔✔effect of tension pneumothorax on heart function - ✔✔increases intrathoracic
pressure
decreases preload/CO
increases afterload
✔✔normal pressure in the vena cavas - ✔✔normally is low
similar to the central venous pressure which is similar to right atrial pressure (2-8mm
hg) so very little increase in pressure to impede venous return to the heart
✔✔what part on the tissue oxygenation cascade is affected by tension pneumothorax -
✔✔ventilation r/t collapsed lung
CO b/c pressure
✔✔why is tension pneumothorax more life threatening than simple pneumothorax -
✔✔tension pneuma is more life threatening than simple b/c of the pressure it puts on
the great vessels so decreased CO
✔✔considerations of chest trauma - ✔✔pneumonia, great vessel trauma, pressure so
low CO
✔✔when is a hospitalized chest patient the most likely to develop tension pneumothrax
- ✔✔when we initiate positive pressure ventilation
✔✔what can rapidly convert a simple pneumothorax to a tension pneumothraox -
✔✔positive pressure can rapidly convert a simple pneumothorax to a tension
pneumothorax (BVM or m. ventilation) or if a chest tube is kinked/clamped/occluded
✔✔chest pain w/breathign - ✔✔pleuritic
✔✔pleuritic chest pain - ✔✔pain with breathing
✔✔assessment of t. pneumothraox - ✔✔pleuritic chest pain (hurts to breathe)
respiratory distress
increased HR
,hyppoxemia
agitation
decreased LS
chest dyspmetry
hyperresonance
✔✔late s/s of tension pneumothrax - ✔✔low bp
JVD
tracheal deviation
✔✔when do you get tracheal deviation - ✔✔late sign of tension pneumothrax
✔✔when isn't JVD & tracheal deviation obvious in tension pneumothroax - ✔✔not
obvious if obese, low bp, cervical collar
also - it is a super late s/s
✔✔intervention if you suspect tension pneumothrax - ✔✔needs FAST
do immediate needle D w/o imaging
✔✔mortality rate off tension pneumothorax - ✔✔100% of patients will die w/o
intervention
✔✔too much black on CXR - ✔✔hyperlucency
✔✔needle "d" for tension pneumo - ✔✔"pop the bubble" with needle/finger.
to restore CO. life saving
✔✔finger thoracotomy - ✔✔
✔✔purpose of "needle d" - ✔✔convert tension pneumo to a simple pneumo.
then put in chest tube
✔✔how to convert a tension pneumothorax to a simple pneumo - ✔✔"needle D"
✔✔open pneumothorax - ✔✔object penetrates or a rib pokes out
✔✔intervention for an ope. pneumothroax - ✔✔xeroform, gasoline bandage, chest seal.
✔✔assessment of the site of a chest tube site - ✔✔consider how it might be a potential
site of an open pneumo
✔✔hemothorax causes problems at what point of the tissue oxygen cascade - ✔✔hgb
availability
ventilation issue b/c lung collapses
, CO problem if enough blood is lost
small venin/arteries below each fib so a broken rib could cause hemothraox
bleeding from intercostal vessels should not be extensive and taper off quickly so
continuous bleeding is likely a different vessel
✔✔considered too much chest tube drainage - ✔✔1-1.5L at initial palcement
50-200ml over 2-4hrs
✔✔how much blood can be in one hemothroax - ✔✔500 - 3L
✔✔% blood loss that is tolerable versus not tolerable - ✔✔most people can tolerate a
10% blood volume loss but most can't tolerate 40%
✔✔how to tell if something is blood or air on a CXR - ✔✔blood = white
black = air
✔✔intervention if hemothorax - ✔✔needs CT
later will need intrapleura tPA or VATS
✔✔VATS - ✔✔video-assisted thoracic surgery
✔✔empyema - ✔✔
✔✔added to blood products that may cause low Ca - ✔✔citrate.
✔✔purpose of citrate in blood products - ✔✔w/o citrate, blood will clot
✔✔keeps blood in blood products from clotting - ✔✔citrate
✔✔priority in bleeding episodes - ✔✔stop bleeding
CABC
✔✔leading cause of early mortality in trauma - ✔✔hemorrhage
✔✔cause of 30 - 40% of all patients who die of trauma - ✔✔hemorrhage
✔✔why is it important to keep a hemorrhage pt warm - ✔✔keep a trauma pt warm helps
stop bleeding b/c you can't clot well if cold
✔✔coagulopathy control in hemorrhage - ✔✔can't clot if we only give RBC/crystallids
needs plasma, cry, plt
✔✔definitive bleeding management - ✔✔OR
